=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710860218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YADIRA PEREZ MANGUAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 2 KM 157.9 BARRIO SABALOS NUEVOS
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-306-8825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB. VALLE HERMOSO ABAJO CALLE AMAPOLA SN18
-----------------------------------------------------
City | HORMIGUEROS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00660-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-306-8825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 004779
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ATAC-200-1-8563
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------